Dr. Remien,
My HIV+ boyfriend and I are interested in having children in the future. Is there any new information about sperm-washing or other risk-reducing procedures for serodiscordant couples? I'm having a hard time locating information on the subject. Your response (and your forum) are greatly appreciated!

Response from Dr. Remien

There are many couples who ask questions about having babies when one or both people are HIV+. Readers should read about some of these issues on the "Pregnancy, Children and HIV" Forum on The Body website.

Many people like yourself want to know about their options for pregnancy and giving birth to an uninfected child when the male in the relationship is HIV+. Most basically, everyone needs to understand that the woman herself must be HIV+ for the baby to be born HIV+. If the woman is not infected with HIV during pregnancy, or at the time of delivery, the baby cannot be born with HIV. However, the risk of intercourse between an HIV+ man and an HIV- woman is that the woman will become HIV infected, leading to the possibility that the baby will become HIV infected, if she becomes pregnant.

Many people have heard of, and ask about, a procedure referred to as "sperm washing." This is a technique by which sperm are separated from the fluids and cells in semen. While sperm cells can have HIV attached to them, most of the virus is in, or attached to, other cells in seminal fluid, and not the sperm itself. The separated or "washed" sperm can then be used for artificial insemination or IVF. As has been stated on this and other forums on The Body, experts known for use of this procedure are Dr. Augusto Semprini in Italy and Drs. Ann Kiessling (Harvard Medical School, Boston) and Mark V. Sauer (Columbia University, New York City) in the U.S. There may be others as well.

I am not a physician and do not work directly with any clinic that is involved with this procedure. However, it is my understanding that arrangements for doing this would be similar to arrangements any couple would need to make for IVF procedures, and that it is rare for insurance to cover this. Unfortunately, it is also my understanding that not all IVF clinics are willing to work with HIV serodiscordant couples.

The following is information I obtained from the New York Columbia site, from Dr. Mark Sauer:

At this time discordant couples must be male(+) and female(-), with women under 40 being the best candidates. Costs are similar to other patients going though IVF, which means roughly $10-12,000 per attempt; whether or not pregnancy occurs. Insurance rarely covers this benefit, although Oxford and US Healthcare/Aetna do have IVF riders. Interested patients should call 646-756-8282.

A contact number for the In vitro fertilization clinic at Johns Hopkins Hospital in Maryland is 410-583-2749. I do not have any more specific information about this site nor any others.

Couples might also want to go to the website of the Assisted Reproduction Foundation (http://www.reproduction.org/).

Any couple that is truly interested in this for themselves should start by talking with their own physician(s). I hope that some of this information is helpful to you and other readers of this Forum.

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